TY  - EJOU
AU  - Rahmat, Budi 
AU  - Fakhri, Dicky 
AU  - Isyawan, Rama Vinnu 
AU  - Haifa, Ghitha Zahra 

TI  - Association of Time Interval between Pulmonary Artery Banding and Bidirectional Cavopulmonary Shunt on Postoperative Outcomes in Univentricular Heart Defect
T2  - Structural and Congenital Heart Disease

PY  - 2026
VL  - 21
IS  - 3
SN  - 3071-1738

AB  - <b>Background:</b> Univentricular heart defects with unrestricted pulmonary blood flow are commonly managed using pulmonary artery banding (PAB) followed by bidirectional cavopulmonary shunt (BCPS) as part of staged palliation, but the optimal interval between these procedures remains uncertain. <b>Methods:</b> This retrospective cohort study evaluated the association between the PAB–BCPS interval and postoperative outcomes after BCPS in patients treated at the National Cardiovascular Center Harapan Kita, Indonesia, from January 2015 to January 2024. Patients with univentricular heart defects and unrestricted pulmonary blood flow who underwent BCPS after prior PAB were included, whereas those undergoing BCPS with major concomitant procedures were excluded. Patients were stratified into <24-month and ≥24-month PAB–BCPS interval groups using a pragmatic median-based cut-off that provided reasonably balanced groups. Outcomes included early mortality, one-year mortality, ventilator duration, intensive care unit length of stay, and postoperative hospital length of stay. <b>Results:</b> A total of 41 patients were included, with a median PAB–BCPS interval of 26 months. Early mortality occurred in 2 patients (4.9%), both in the <24-month group, whereas no early mortality occurred in the ≥24-month group; however, this difference was not statistically significant [2/19 (10.5%) vs. 0/22 (0%); <i>p</i> = 0.209]. One-year mortality was also not significantly different between groups [5/19 (26.3%) vs. 3/22 (13.6%); <i>p</i> = 0.436]. Ventilator duration, intensive care unit length of stay, and postoperative hospital length of stay were comparable between groups. Exploratory Firth’s penalized logistic regression suggested that a longer PAB–BCPS interval was associated with lower odds of early mortality, but this finding should be interpreted cautiously because only two early mortality events occurred. Linear regression analysis showed that the PAB–BCPS interval was not significantly associated with ventilator duration, intensive care unit length of stay, or hospital length of stay. Higher preoperative mean pulmonary artery pressure was significantly associated with longer ventilator duration and intensive care unit stay. <b>Conclusions:</b> These findings suggest that hemodynamic readiness may be more clinically relevant than interval duration alone when determining suitability for BCPS after PAB. Larger multicenter studies are needed to validate these hypothesis-generating findings.
KW  - Time interval; pulmonary artery banding; bidirectional cavopulmonary shunt; univentricular heart defects; unrestricted pulmonary blood flow

DO  - 10.32604/schd.2026.077573